R320 – Non-autologous or prosthetic implant (without septorhinoplasty)
OHIP Radiology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure for a non-autologous or prosthetic implant to the nose. The fee includes pre-operative and post-operative care as outlined in the Surgical Preamble (). As per the Surgical Preamble (, ), the fee for this service includes pre-operative hospital visits one or two days prior to surgery and post-operative care for up to two weeks, excluding the first and second post-operative visits and the day of discharge visit by the MRP. The major pre-operative assessment where the decision to operate is made is claimed separately.
When to Use
- Use R320 when performing a nasal augmentation or reconstruction using a synthetic or non-autologous implant where no septorhinoplasty is performed.
- Use this code for the insertion of a prosthetic nasal dorsal implant to correct contour deformities in patients where autologous cartilage is not utilized.
Common Pitfalls
- Billing R320 without obtaining prior written authorization from a Ministry of Health medical consultant will result in an automatic rejection.
- Attempting to claim a hospital admission assessment or routine pre-operative visit on the day before or day of surgery is a common error, as these are included in the R320 fee.
- Failing to append the correct suffix (A for surgeon, B for assistant, C for anaesthetist) will lead to claim rejection.
Billing Tips
- Ensure the major pre-operative consultation fee is billed separately on the date the decision to operate is made, as it is not included in the R320 surgical benefit.
- Remember that the first and second post-operative visits in the hospital are billable as subsequent visits, despite the 14-day post-operative care period included in the R320 fee.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Written prior authorization by a Ministry of Health medical consultant is required.
The surgical benefit does not include the major pre-operative visit - i.e. the consultation or assessment fee which may be claimed when the decision to operate is made and the operation is scheduled, regardless of the time interval between the major pre-operative visit and surgery.
The hospital or day care admission assessment (consultation, repeat consultation, general or specific assessment or re-assessment, partial assessment) may not be claimed by the surgeon unless it happens to be the major pre-operative visit as defined above.
Pre-operative hospital visits which take place 1 or 2 days prior to surgery are included in the surgical fee.
Post-operative care and visits associated with the procedure for up to two weeks post-operatively, and making arrangements for discharge, to a hospital in-patient are included in the surgical fee, with specific exceptions.
Exceptions to included post-operative care are: the first and second post-operative visits in hospital (payable at the specialty specific subsequent visit fee); and subsequent visit by the Most Responsible Physician (MRP) - day of discharge (C124).
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